Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Int J Cancer. 2018 Nov 15;143(10):2499-2504. doi: 10.1002/ijc.31639. Epub 2018 Sep 19.
Toremifene (TOR) is a valid and safe alternative to tamoxifen (TAM) for adjuvant endocrine therapy in breast cancer patients with a metabolic pathway that differs from that of TAM. TOR might have a therapeutic advantage in certain subgroups of patients, such as Chinese women with the CYP2D6 *10 (c.100C > T) T/T genotype, who would get less benefit when receiving adjuvant TAM treatment. A total of 230 breast cancer patients who received adjuvant TAM (n = 115) or TOR (n = 115) at the National Cancer Center were analyzed. The CYP2D6 *10 genotype was not significantly associated with DFS in patients who received TOR (p = 0.737). Patients treated with TOR had a higher 5-year disease-free survival (DFS) rate than those treated with TAM (89.6% vs. 80.9%, p = 0.009). TOR treatment remained an independent prognostic marker of DFS in multivariate analysis compared with TAM (hazard ratio = 0.51; p = 0.014). For all of the 50 CYP2D6 *10 T/T genotype patients, TOR treatment group had a significantly higher 5-year DFS rate than TAM group (90.9% vs. 67.9%, p = 0.031). For the remaining 170 CYP2D6 *10 C/C or C/T genotype patients, there was no significant difference between the 5-year DFS rates of the TOR and TAM groups (89.2% vs. 85.1%, p = 0.188). The advantage of adjuvant TOR over TAM in Chinese breast cancer patients might be caused by the significant benefit obtained by the CYP2D6 *10 T/T patients, who accounted for one-fifth of the overall population. TOR might be a good option for adjuvant endocrine therapy in this subgroup of patients in China.
托瑞米芬（TOR）是一种有效的、安全的替代他莫昔芬（TAM）的药物，可用于代谢途径不同于 TAM 的乳腺癌患者的辅助内分泌治疗。TOR 可能在某些特定亚组患者中具有治疗优势，例如中国 CYP2D610（c.100C>T）T/T 基因型的女性，她们在接受辅助 TAM 治疗时获益较少。对在中国国家癌症中心接受辅助 TAM（n=115）或 TOR（n=115）治疗的 230 名乳腺癌患者进行了分析。CYP2D610 基因型与接受 TOR 治疗的患者的无病生存期（DFS）无显著相关性（p=0.737）。与接受 TAM 治疗的患者相比，接受 TOR 治疗的患者 5 年无病生存率（DFS）更高（89.6% vs. 80.9%，p=0.009）。与 TAM 相比，在多变量分析中，TOR 治疗仍然是 DFS 的独立预后标志物（危险比=0.51；p=0.014）。对于所有 50 名 CYP2D610 T/T 基因型患者，TOR 治疗组的 5 年 DFS 率明显高于 TAM 组（90.9% vs. 67.9%，p=0.031）。对于其余 170 名 CYP2D610 C/C 或 C/T 基因型患者，TOR 和 TAM 组的 5 年 DFS 率无显著差异（89.2% vs. 85.1%，p=0.188）。在中国乳腺癌患者中，辅助 TOR 优于 TAM 的优势可能归因于 CYP2D6*10 T/T 患者获得的显著获益，而 T/T 患者占总体人群的五分之一。在中国，对于这一小部分患者，TOR 可能是辅助内分泌治疗的一个不错选择。
